SOCIOECONOMIC DETERMINANTS OF FRAILTY TRAJECTORIES AMONG OLDER ADULTS IN SWITZERLAND (2004–2020)

Abstract Frailty in old age is a major public health challenge. Frail older adults are at higher risk of adverse health outcomes and in greater needs for health services as compared to non-frail older adults. An emerging perspective views frailty as a dynamic process and older adults are likely to transition to improved frailty status. However, little is known about the socioeconomic determinants of frailty trajectories over the later life course. This study investigated how frailty evolves and transitions over time and how socioeconomic status impacts frailty trajectories. Data from the Survey of Health, Ageing and Retirement in Europe 2004-2020 (N=4,621 adults aged 50-105 in Switzerland) were analyzed. Fried’s phenotype was used to operationalize frailty. Changes in frailty status at a 2-year interval were used to identify frailty trajectories. Growth curve models were performed to investigate how age, sex, education, occupation, and income determined frailty trajectories over the later life course. This study had three findings. First, three frailty states were identified: non-frail, pre-frail, and frail. Second, five frailty trajectories were identified: stable frail, worsening, mixed, improving, and stable non-frail. Third, individuals aged 65 and above, women, and socioeconomically disadvantaged individuals had a higher risk of being stable frail and having a worsening frailty trajectory. Findings indicate that frailty intervention programs in Switzerland need to prioritize individuals in middle age and old age, women, and individuals with lower socioeconomic status to tackle the challenge of frailty.

by a modified version of Fried's criteria.Isotemporal substitution analysis was performed to investigate the association between 24-h movement and risks of pre-frailty and frailty.Results: After adjusting confounding variables, the results also indicated that only reallocating 60 minutes of SB per day to MVPA was less likely to have pre-frailty (OR = 0.01, 95% CI = 0.01, 0.20) and frailty (OR = 0.02, 95% CI = 0.02, 0.36).In addition, each 5-min increment in MVPA from 20 min as part of total physical activity (40 min in LPA) to replace 60 minutes of SB per day resulted in being less likely to have frailty (OR = 0.546,95% CI= 0.301,0.992).Conclusions: This study demonstrated that using 60-min MVPA to substitute SB daily may theoretically reduce the risk of being pre-frailty and frailty.Moreover, replacing 60-min SB daily with mixed 40-min LPA and 20-min MVPA was able to reduce frailty risks.Therefore, those findings may provide alternative approaches with acceptable intensity and feasibility when promoting the physical health of older adults.

LIFESTYLE CHANGES AFTER FRAILTY ONSET AMONG MIDDLE-AGED AND OLDER ADULTS IN THE UNITED STATES
Hui-wen Xu, Yu-Ming Chen, Zhou Yang, and Bei-bei Xu, Peking University, Beijing, Beijing, China (People's Republic) Frailty could be the teachable moment to promote a lifestyle change for middle-aged and older adults.This study aimed to investigate the impact of sociodemographic characteristics on lifestyle changes among frail adults aged ≥50 years.A total of 5,440 frail individuals aged ≥50 years from the Health and Retirement Study (HRS) 2004-2020 were included.The Paulson-Lichtenberg Frailty Index was used to measure frailty.Lifestyle included smoking status, alcohol consumption, physical activity, and sleep problems.Logistic regression models were used to examine the associations between sociodemographic characteristics and lifestyle change among frail participants.After frailty, a higher proportion of individuals reported maintaining their smoking and drinking status without change.Compared to increased physical activity, more people reported reducing their low, moderate, and high-intensity physical activity.Similarly, a greater proportion of individuals reported worsened sleep problems compared to those who experienced improvements in sleep problems.Age was negatively associated with quitting smoking and increased light, moderate, as well as vigorous physical activity, while was positively associated with improving sleep problems.Males were more likely to quit smoking, quit drinking, and increase light physical activity.Individuals with medium and high education levels were more likely to quit drinking and less likely to increase moderate physical activity.A sensitivity analysis based on the 4-year interval between pre-diagnosis and post-diagnosis of frailty showed that being unmarried was associated with an increased likelihood of quitting smoking.Some people reported lifestyle changes after frailty.Age, gender, marital status, and education levels may affect lifestyle changes after frailty.
Abstract citation ID: igad104.3043Resilience-promoting factors (RPF), minority race and their interaction, were evaluated as determinants of quality of life (QOL) decline in a nationally representative sample of US adults ≥50 years old (N=3932) with heart disease and/ or type-2 diabetes from 2006-2014 as part of the Health and Retirement Study.RPF included personal mastery and positive social support (PSS).QOL was assessed by self-rated health (SRH) and defined as poor (fair/poor), good, or excellent (very good/ excellent).Repeated measures multinomial regression using generalized estimating equations (GEEs) related RPF, race, and their interaction to SRH declines over 8 years.Odds ratios (OR) and 95% confidence intervals (CIs) were calculated with adjustment for time, sociodemographic and behavioral confounders.Low mastery, low PSS and minority race were each associated with higher odds of QOL declines over 8 years (mastery OR-2.27, 95% CI: 1.83-2.81;PSS OR-1.35, 95% CI: 1.10-1.65;African American OR-1.46,95% CI: 1.25-1.70,and Other race OR-1.43, 95% CI: 1.10-1.86).QOL declines related to PSS-friends varied by race and time (race x time x PSS-friends, p=0.093).Among older Caucasians, the association between PSS and QOL declines did not vary over time (p=0.676).However, among African Americans and Other race, low PSS was associated with increased odds of QOL declines over time (p=0.031and p=0.034 respectively).RPF and minority race predicted QOL decline in older Americans with comorbid conditions.Policies/ interventions to enhance resiliency represent a viable strategy for mitigating racial disparities in overall wellbeing and improving health outcomes in aging Americans.

LOW RESILIENCE FACTORS AND MINORITY RACE PREDICT QUALITY-OF-LIFE DEFICITS AMONG OLDER ADULTS WITH CHRONIC DISEASE
Abstract citation ID: igad104.3044

SOCIOECONOMIC DETERMINANTS OF FRAILTY TRAJECTORIES AMONG OLDER ADULTS IN SWITZERLAND (2004-2020)
Mengling Cheng, Swiss Centre of Expertise in Life Course Research, Lausanne, Vaud, Switzerland Frailty in old age is a major public health challenge.Frail older adults are at higher risk of adverse health outcomes and in greater needs for health services as compared to nonfrail older adults.An emerging perspective views frailty as a dynamic process and older adults are likely to transition to improved frailty status.However, little is known about the socioeconomic determinants of frailty trajectories over the later life course.This study investigated how frailty evolves and transitions over time and how socioeconomic status impacts frailty trajectories.Data from the Survey of Health, Ageing and Retirement in Europe 2004-2020 (N=4,621 adults aged 50-105 in Switzerland) were analyzed.Fried's phenotype was used to operationalize frailty.Changes in frailty status at a 2-year interval were used to identify frailty trajectories.Growth curve models were performed to investigate how age, sex, education, occupation, and income determined frailty trajectories over the later life course.This study had three findings.First, three frailty states were identified: non-frail, pre-frail, and frail.Second, five frailty trajectories were identified: stable frail, worsening, mixed, improving, and stable non-frail.Third, individuals aged 65 and above, women, and socioeconomically disadvantaged individuals had a higher risk of being stable frail and having a worsening frailty trajectory.Findings indicate that frailty intervention programs in Switzerland need to prioritize individuals in middle age and old age, women, and individuals with lower socioeconomic status to tackle the challenge of frailty.

TRENDS IN FRAILTY INCIDENCE AND THE IMPACT OF LIFESTYLE AMONG US ADULTS AGED ≥50 YEARS FROM 2004 TO 2020
Hui-wen Xu, Yu-Ming Chen, Zhou Yang, and Bei-bei Xu, Peking University, Beijing, Beijing, China (People's Republic) Few studies have estimated frailty incidence.The contribution of lifestyle to the incidence of frailty may change over time.It is necessary to quantify the impact of lifestyle on frailty incidence over time.A of 25,639 subjects aged ≥50 years from the Health and Retirement Study (HRS) 2004-2020 were divided into seven consecutive and overlapping cohorts.Frailty was measured using the Paulson-Lichtenberg Frailty Index.Lifestyle included smoking status, alcohol consumption, physical activity, and sleep problems.The trend of frailty incidence rates was estimated by generalized estimating equation (GEE) models with a natural cubic spline.Population attributable fractions (PAFs) were calculated using hazard ratios from Cox models.Lifestyle-attributable frailty incidence rates were estimated by multiplying PAFs by the overall incidence rate of frailty.The incidence (per 1,000 person-years) of frailty showed a general trend of first decreasing and then increasing, with a peak occurrence of 22.7 (95% CI: 21.0, 24.5) in 2010-2014.Almost 20% of frailty incidence rates were attributed to current smoking, physical inactivity, or sleep problems.The incidence of frailty showed a fluctuating but decreasing trend among middle-aged and older adults in the United States from 2004 to 2020, with a peak occurrence after the Great Recession of 2007-2009.Smoking, physical inactivity, and sleep problems may have contributed importantly to the incidence of frailty.Effective and early frailty prevention strategies should be developed to reduce smoking, physical inactivity, and sleep problems, especially in the context of the global economic crisis caused by the COVID-19 epidemic.

ADVERSE CHILDHOOD EXPERIENCES AND DEPRESSIVE SYMPTOMS IN MIDDLE-AGED AND OLDER CHINESE ADULTS
Wenxing Wei, and Aloen Townsend, Case Western Reserve University, Cleveland, Ohio, United States Prior research has shown a significant effect from adverse childhood experiences (ACEs) to depressive symptoms in later adulthood, but there is very limited research on this relationship in China.This study examines the relationship between multiple childhood adversity indicators (childhood abuse, bullying victimization, and witnessing violence) and depressive symptoms in Chinese middle-aged and older adults by gender.The study was based on a nationally representative sample of 10,371 participants aged 45 and older collected through the China Health and Retirement Longitudinal Study (CHARLS).Childhood adversity indicators in the 2014 Life History Survey were merged with the harmonized 2018 CHARLS dataset.Structural equation modeling was conducted separately for males and females because the measurement model was not invariant by gender.Childhood abuse was not a significant predictor for either gender but bullying victimization and witnessing violence were significant.Witnessing violence was a stronger predictor for females (gamma = .15,p < .001)than for males (gamma = .08,p < .05).For both groups, childhood adversity variables together accounted for 6% variance in depressive symptoms.Experiences of being bullied in school and community and witnessing violence in the family were still influential in middle and late life.Figuring out what role ACEs are playing and how to deal with their effects are vital to providing more effective prevention and interventions.Further investigations are required, for example, regarding the mechanisms behind the significant relationships and why childhood abuse was not a significant predictor among this Chinese sample.

AN INTERNATIONAL PERSPECTIVE ON GOAL SETTING AND INTERDISCIPLINARY COLLABORATION WITHIN REABLEMENT PROGRAMS
Lise Buma 1 , Hanne Tuntland 2 , Sandra Zwakhalen 1 , and Silke Metzelthin 3 , 1. Maastricht University, Maastricht, Limburg, Netherlands, 2. Western Norway University of Applied Sciences,Bergen,Hordaland,Norway,3. Maastricht University,Care and Public Health Research Institute,Maastricht,Limburg,Netherlands Over the last two decades, reablement has been studied and implemented in more than 16 countries.It is a personcentred approach aiming to enhance individuals' (physical) functioning and increase or maintain their independence in meaningful activities.Goal setting and interdisciplinary collaboration are identified as important key elements of reablement.Due to limited intervention descriptions in the scientific literature, it is not clear how these two elements are applied in practice.This hinders the uptake of reablement services among healthcare care providers on national and international level.This study aimed to provide insight into: (1) goal setting; and (2) interdisciplinary collaboration within reablement programs.Therefore, a qualitative study in Norway and the Netherlands was conducted.In both countries, reablement staff (n=14) was interviewed.Data was analysed using both deductive and inductive content analysis.To increase rigor in terms of credibility, transferability, dependability and conformability; member checking, uniform Allan Nkwata 1 , Xiao Song 2 , Ming Zhang 2 , and Amara Ezeamama 3 , 1. University of Michigan, Ann Arbor, Michigan, United States, 2. University of Georgia, Athens, Georgia, United States, 3. Michigan State University, East Lansing, Michigan, United States